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PubMed1979

Behaviour therapy as precipitant and treatment in a case of dual personality.

The patient described is a 33-year -old woman, L.,who developed a transient dual personality while undergoing desensitization for contact phobia, the alternate personality, Toni, manifesting overtly aggressive behaviour. L. was taught how to behave angrily using role-playing techniques within 48 hours of Toni's first appearance and the alternate personality did not reappear after this treatment was commenced. It is suggested that behavioural psychotherapy may, in some instances of multiple personality, have advantages over psychodynamically oriented psychotherapy, which has frequently been advocated as the treatment of choice for this condition.

Adult↗
PubMed1982

A treatment outline for agoraphobia. The Quality Assurance Project.

The Royal Australian and New Zealand College of Psychiatrists has initiated a project to develop treatment outlines for various psychiatric disorders. It is envisaged that the present outline, which was developed by a project team and an expert committee may be modified by the College before being used in post graduate and continuing education and in peer review. In its present form it should be of use to practising psychiatrists. Comments and criticisms on this outline are welcome. A loose-leaf insert is included so that interested readers may respond, either directly to the project team or indirectly via the Editor. This is the first of a series of treatment outlines and concerns the diagnosis and treatment of agoraphobia. The next outline will be on the treatment of depressive illness.

Agoraphobia↗
PubMed1995

Respiratory training prior to exposure in vivo in the treatment of panic disorder with agoraphobia: efficacy and predictors of outcome.

Thirty-two patients suffering from panic disorder with agoraphobia were treated with repeated hyperventilation provocations and respiratory training, followed by exposure in vivo. The treatment was evaluated with a comprehensive set of outcome measures, including self-report questionnaires, a multitask behavioural avoidance test and continuous monitoring of panic. The treatment was found effective for the majority of patients in diminishing the frequency of panic attacks and agoraphobic avoidance. The clinical relevance of the treatment effect was evidenced by the considerable number of patients that recovered. The effect of the treatment was sustained over a three and six month follow-up period. The prognostic value of a number of variables for treatment outcome was also investigated. Three variables accounted for the majority of the variance in treatment outcome: a higher pretreatment level of agoraphobic complaints, use of psychotropic medication and a longer duration of the disorder were associated with poorer outcome. Other variables, such as the therapeutic relationship and the quality of the marital bond, had no prognostic value.

Adult↗
PubMed1998

A pilot study of computer-aided vicarious exposure for obsessive-compulsive disorder.

OBJECTIVE: This study reports the use of an interactive computer program to instruct vicarious exposure and ritual prevention for obsessive-compulsive disorder (OCD). METHOD: Thirteen OCD volunteers and 10 non-OCD volunteers completed three 45-minute sessions at weekly intervals. Subjects with OCD completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Padua Inventory (PI) and the Beck Depression Inventory (BDI) 1 week prior to and 1 week after the three computer treatment sessions. Non-OCD subjects only completed these measures at baseline, allowing confirmation that they had no significant level of OCD symptomatology. RESULTS: In the OCD subjects, scores fell significantly on the PI and BDI, and Y-BOCS scores fell non-significantly. Engagement in vicarious exposure with ritual prevention improved from sessions 1-3. Compared to the non-OCD participants, OCD subjects did less vicarious exposure in session 1 but not sessions 2 and 3. Performance of vicarious exposure by OCD subjects in session 1 correlated with pre-post improvement in PI and BDI scores. CONCLUSIONS: The vicarious exposure program may have a role to play as an adjunct in behaviour therapy.

Adolescent↗
PubMed1975

A behavior modification training program for staff working with drug addicts.

This paper described a Behavior Modification Training Program, emphasizing self-control, for staff working with drug addicts. The program, which is primarily geared toward the training of paraprofessionals, takes place in ten 1-1/2 hour sessions and includes an overview of behavior modification as well as instruction in techniques of relaxation, desensitization, self-image improvement, behavior analysis, behavior control, assertive training, rational thinking, and how to set up and run similar behavior modification training programs for staff and patients. Since this training began at the New Jersey Neuropsychiatric Institute in November 1971, a total of 898 staff members, mostly paraprofessionals working with addicts, alcoholics, mentally ill patients, and inmates, including 53 from our own institution, 576 persons from other facilities in New Jersey, and 269 from facilities in other states, have been trained, while 2,021 patients have been trained in similar programs. Most of this training has been accomplished by paraprofessionals. Preliminary evaluation data have been promising and the response of participants enthusiastic.

Allied Health Personnel↗
PubMed1991

Postwithdrawal exposure treatment to prevent relapse in opiate addicts: a pilot study.

A major problem in treating opiate addiction is relapse within a few months after withdrawal. Learning models of relapse offer some promise toward understanding this problem. The present pilot study examines whether cue-exposure treatment to drug-related cues, in hospital and real life, might reduce relapse. Fourteen opiate addicts were withdrawn on clonidine over 6 days, and 10 of those were exposed to drug-related cues in hospital for 1 week and in real life for another. There were then followed as outpatients up to 6 months. Craving was elicited in half of the 10 patients exposed to drug cues who showed within- and between-session habituation. Four cases were opiate-free at 6 months follow up and 1 at 3 months. Half of the cases had relapsed to heroin at various times up to 6 months. Habituation to craving responses was not obviously related to outcome whereas vocational factors were. The operational use of craving in research is discussed.

Adult↗
PubMed2004

[What is the place of emotion in cognitive-behavioral approaches of obsessive-compulsive disorders?].

The efficacy of behavioral techniques based on exposure and response prevention has been well validated in the treatment of obsessive-compulsive disorder. Nevertheless in a large proportion of patients the disease persists, among others due to refusal of the treatment or due to non-response. About one of two patient entering treatment seems therefore to possibly benefit from behavioral therapy (Ladouceur et al., 1999). Cognitive techniques may extend the behavioral approach, and may represent a more indirect and progressive method, and may improve patients' commitment in the therapy. However, the proportion of treatment resistant patients remains important. New techniques are therefore warranted in order to progress in the understanding and treatment of these patients. Emotion focused therapy could possibly represent an interesting approach based on the improvement of emotional awareness, the exploration and the cognitive restructuring of emotions. The different techniques are described throughout clinical case reports.

Adult↗
PubMed2004

[Do cognitive-behavioral group therapies in the treatment of anxiety disorders have an advantage over individual treatments?].

Group cognitive-behavior therapies in the treatment of anxiety disorders for adult psychiatric patients were historically developed on the basis of validated individual treatments. They have been widely employed and studied for social phobia, panic disorders, agoraphobia and obsessive-compulsive disorders, with generally positive results similar to those obtained with the corresponding individual methods. The cognitive-behavioural group treatments for generalized anxiety and posttraumatic stress disorders have not yet received sufficient validation. The results of evaluative research show that the format of the therapy (individual or group) does not appear to predict the outcome. Therefore an indication for an individual or a group therapy cannot be made on the basis of the diagnosis alone. It has to be based on other criteria, in particular economical, organisational or clinical. Group therapies can certainly offer advantages in comparison with individual procedures, even if they cannot always fit perfectly the specific needs of every patient. Indication has to be made individually, in order to allow the therapists to judge their patients' capacities and interest to participate in a group program.

Agoraphobia↗
PubMed1998

Comparing virtual and real worlds for acrophobia treatment.

Traditional treatment of phobias involves a process of gradual exposure to the feared object. Virtual Reality (VR) environments have been used to effectively treat phobias by simulating feared situations, yet these initial studies have been performed by comparing the effect to no-treatment conditions. We are in the process of comparing VR exposure treatment to "gold-standard" in-vivo exposure treatment by replicating an actual in-vivo exposure area in a VR model. The process of controlling for differences between the two environments highlights a general procedure of selecting elements in virtual environment design, targeted towards producing particular emotional effects. It also raises questions about the necessity for highly realistic simulation in VR phobia treatment.

Behavior Therapy↗
PubMed1999

Anxiety disorders in late life.

OBJECTIVE: To review the epidemiology, clinical characteristics, and treatment of anxiety disorders in late life. QUALITY OF EVIDENCE: Epidemiologic and comorbidity data are derived from well designed random-sample community surveys. There are virtually no controlled data specific to treatment of anxiety in the elderly. Guidelines for treating anxiety disorders in late life, therefore, must be extrapolated from results of randomized controlled trials conducted in younger patients. MAIN MESSAGE: Generalized anxiety disorder and agoraphobia account for most cases of anxiety disorder in late life. Late-onset generalized anxiety is usually associated with depressive illness and, in this situation, the primary pharmacologic treatment is antidepressant medication. Most elderly people with agoraphobia do not give a history of panic attacks; exposure therapy is the preferred treatment for agoraphobia without panic. CONCLUSIONS: Physicians need to make more use of antidepressant medication and behavioural therapy and less use of benzodiazepines in treating anxiety disorders in late life.

Agoraphobia↗